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Scottish study looks at experiences of people who have adminsted naloxone

A new piece of research has been published that explores the experiences of people who inject drugs in Scotland who have administered take-home naloxone to a person who was encountering an opioid overdose.

Naloxone is a lifesaving medication that can temporarily reverse the effects of opioid overdose, buying vital extra time until emergency services arrive.

Scotland has had a National Naloxone Programme – led by SDF – since 2011, which has increased the supply of naloxone, and generated a considerable body of evidence that it can save lives.

However, less has been known about the lived experiences of people who inject drugs with administering naloxone, despite the potential for this to inform policymakers’ decisions about the adoption of ‘take-home naloxone’ programmes in nations where none yet exist, as well as in nations where national programmes do exist but may require modification in order to achieve the best results.

The study ‘Lived experience of take-home naloxone administration by people who inject drugs’ involved face-to-face interviews with eight people known to have used take-home naloxone in an overdose situation. Participants were recruited from a harm reduction service in a large urban area in Scotland. Half had been using opioids for over 10 years, and half were still injecting drugs at the time of the interview, though all were injecting at the time of the overdose event when they used naloxone. Five had previously overdosed.

One of the overarching findings was that responding to an overdose administering take-home naloxone was challenging for those involved – but despite this, participants appeared to remain committed to using naloxone in their communities, with some even feeling obligated to intervene in future overdoses.

Looking back to the first time they administered naloxone, participants described the scene as chaotic – emphasising their alarm, anxiety, and panic. These emotions were linked to feeling unprepared, wanting to respond quickly, being concerned about the person in danger, and afraid of being blamed ‘whatever the outcome’. Some participants also put their apprehension down to their inexperience with witnessing an overdose, administering naloxone, or of injecting others. These stresses – alone or in combination – often contributed to overdose responses based on instinct rather than on following protocol.

While all the participants saw themselves as legitimate overdose responders, sometimes their peers agreed with this and sometimes they did not. There was also variation in how participants perceived their ability to help in the case of an overdose, with some supremely confident in their skills, and others less assured at the outset but gaining confidence after administering it for the first time. One participant described this in the following way: “Once I’d done it … it was like writing your name, you know. It was something you know you’re capable of and you’re no gonna be worried about it.”

On some occasions, peers that participants attempted to help were reportedly verbally and physically abusive. The reasons for these negative responses were wide ranging and included a lack of awareness that the overdose could be fatal, the naloxone causing acute withdrawal, people feeling ‘robbed of their hit’, and intervening in a suicide attempt.

After seeing naloxone work, participants started to view their own role as a lifesaver. Among some participants, access to naloxone increased their sense of responsibility toward their peers – causing them to realise that they were able to save others where they previously might not have been able to. After seeing the naloxone work, they viewed their own roles as that of a lifesaver.

According to Drug and Alcohol Findings, the study could have important implications for overdose prevention policy and practice in Scotland and the UK by providing the first detailed insights into how people who inject drugs experience this key public health policy. Stories of successful ‘saves’ described in this research could also be used to inform policymakers and practitioners when developing materials to communicate take-home naloxone to a wider audience – something vital in normalising naloxone in communities and reducing stigma, while at the same time positioning people who inject drugs as responsible and important community public health resources.